John Lienhard presents guest Stanley Reiser
Today, medical ethicist Stanley Reiser visits a legendary physician. The University of Houston presents this series about the machines that make our civilization run, and the people whose ingenuity created them.
Hippocrates, alive some 2,500 years ago, continues to influence doctors and patients through essays on the ethics of medical work. Most famous is The Oath. It begins: "I swear by Apollo physician, by Asclepius, by Health, by Panacea and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture." These words tell the novice students for whom it was written: don't take this Oath lightly.
The meaning of the next passage has been controversial. It asks students to care for their teachers, share income with them, and when they become doctors to give their knowledge only to those who take the Oath. For me, the promise of a life-long relationship by students with teachers was not a venal effort to use student labor to gain security, as some interpret it. Rather, the relationship bonded students to their teachers' values, the ones contained in the Oath. Further, so important was the students' promise to follow these values, that those who did not, would not be taught medicine and given its power.
The Oath also states that to use the knowledge of medicine wisely entails two fundamental qualities: the ability to proficiently apply its methods -- a technical skill, and the judgment to know when their use was appropriate -- an ethical skill. But the Oath warns that neither ability nor judgment alone
can properly guide the doctor.
These ideas prepared the Oath-taker to apply specific ethical principles addressed later by Hippocrates in the Oath. They are to use therapy only when a benefit was expected and to avoid preventable risks when doing so (an idea stated in another Hippocratic document as the "do no harm" precept). The Oath forbids endangering or ending human life anywhere from its fetal to its mature stages. It also speaks against taking advantage of a sick person's vulnerability, taking actions that endanger the doctor's moral standing, or revealing facts about a patient's life to others -- the origin of our modern concern with the issue of confidentiality.
It concludes by promising enduring honor to doctors who follow its precepts and infamy to those who don't.
Today the original Hippocratic Oath is rarely given. Its ideas on the student-teacher relationship, and its resistance to all measures that shorten life are too controversial for a diverse group of modern students to accept. So now there are "modern forms" of the Oath that omit these subjects but introduce others. I heard one given to medical students at my daughter's graduation. Unfortunately, no one told the audience it was not the original version. That was distracting to me but no matter. A message was sent that ethics still mattered to doctors, and the audience seemed pleased.
They should have been. In the modern world of technological medicine, the conscience of doctors, fortified by the ethical thinking that Hippocratic ideals have stimulated, is an increasingly dependable moral compass and patient safeguard.
I'm Stanley Joel Reiser from the University of Texas Health Science Center, where we try to connect ethical action to the way inventive minds work.
I'm John Lienhard, at the University of Houston, where we're interested in the way inventive minds work.
Stanley Joel Reiser, MD, MPA, PhD, is the Griff T. Ross Professor of Humanities and Technology in Health Care at the University of Texas Health Science Center at Houston. His most recent book is: R. E. Bulger, E. Heitman, and S. J. Reiser, The Ethical Dimensions of the Biological and Health Sciences. New York: Cambridge University Press, 2002.
Hippocrates. The Oath. Hippocrates (W. H. S Jones, ed.) Vol. 1, Cambridge, MA: Harvard University Press, 1962, 299-301.
S. J. Reiser, What Modern Physicians Can Learn from Hippocrates. Cancer,Vol. 98 No. 8, 2003, pp. 1555-1558.
Frontispiece of a 1571 edition of the Aphorisms of Hippocrates. The symbol at the bottom of the page is the traditional Staff of Asclepius, a sign of the Greek God of healing. (Image courtesy of the John P. McGovern Historical Collection and Research Center)
19th-century image of a woman learning anatomy. By this time, medicine had embraced dissection which would not have been performed by a Hippocratic doctor, nor would it have been sanctioned by Hippocratic thinking as it was expressed in the original Oath.